BRG Quarterly Compliance Developments

Jan 31, 2023 | BRG Publications

The BRG Healthcare Transactions and Strategy quarterly compliance bulletin compiles noteworthy developments in the healthcare sector related to compliance, program integrity, and enforcement activities. In the fourth quarter of 2022, we have taken note of: DOJ/HHS Activity OIG Report on Medicare Part B Lab Spending OIG Workplans Two Comparative Billing Reports One Proposed Addition to RAC Audit List One GAO Report OCR Activity Click to read more. 

Managed Care Friday

Jan 27, 2023 | Managed Care Friday

38: The percentage of Americans who delayed healthcare treatment due to costs in 2022, a 12% increase compared to 2020 and 2021, according to a recent survey by Gallop. More than a quarter of those said the care they skipped was for “very” or “somewhat” serious conditions. Lower-income people, younger adults and women were more likely to delay care. In our own poll, nearly 75% of college age to 28-year-old males tend to skip care, not due to cost but due to fear. Fertile Ground: About one-third of infertility cases are caused by male reproductive issues, according to a study by the NIH....

2023 Value-Based Care Evolution

Jan 26, 2023 | BRG Publications

Value-based care (VBC) has been one of the most recognizable healthcare buzzwords of the past decade, with government, commercial payers, and industry stakeholders investing in developing more value-based arrangements (VBAs) that link payment to performance. Both providers and payers expect these VBAs to increase, although perceptions of where we are in this trend differ. In this paper, we provide a snapshot of spending trends, a primer on the spectrum of value-based arrangements, and guidance on successful negotiation. Click to read more.

Weekly Medicaid Update

Jan 25, 2023 | Medicaid

The brief highlights recent Medicaid policy developments in key states over the past week, including, but not limited to: MN: Governor's proposed budget includes increased rates for waiver services​ NC: Proposes policy to cover autism treatment for adults​ WA: Begins distributing behavioral health provider relief funds Click to read more. 

Significant ACO Reforms Finalized

Jan 24, 2023 | Medicare

CMS has finalized significant reforms to the Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs). In general, the policy changes ease the difficulty of remaining in the ACO program. ACOs will face less-difficult benchmarks and will be able to maintain one-side risk for longer periods. Click to read more.